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Emotional Instability Reaction Term

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Josephine

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  • HadIt.com Elder

Emotional Instability Reaction _ code 460 - may not always be a " Personality Disorder"?

[

Citation Nr: 0302710

Decision Date: 02/12/03 Archive Date: 02/19/03

DOCKET NO. 99-19 695 ) DATE

)

)

On appeal from the

Department of Veterans Affairs Regional Office in No. Little

Rock, Arkansas

THE ISSUE

Entitlement to service connection for an anxiety disorder.

REPRESENTATION

Appellant represented by: The American Legion

WITNESSES AT HEARING ON APPEAL

Appellant and spouse

ATTORNEY FOR THE BOARD

J. D. Deane, Associate Counsel

INTRODUCTION

The veteran served on active duty from August 1958 to March

1959.

This case comes before the Board of Veterans' Appeals (Board) from a July 1999 rating decision of the North Little Rock, Arkansas, Regional Office (RO) of the Department of Veterans

Affairs (VA).

The Board remanded the veteran's claim in July 2001 for action consistent with the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000) (codified as amended at 38 U.S.C.A. § 5100 et seq. (West Supp. 2001)). In August 2002, the Board further developed

the claim, ordering a VA examination to evaluate the veteran's disability.

The veteran had a personal hearing before the undersigned

Member of the Board in May 2001.

FINDINGS OF FACT

1. All evidence requisite for equitable disposition of the veteran's claim for service connection has been obtained and examined, and all due process concerns as to the development

of the claim have been addressed.

2. The veteran has a current anxiety disorder, which was diagnosed as an emotional instability reaction during his military service.

CONCLUSION OF LAW

An anxiety disorder was incurred in active service. 38 U.S.C.A. §§ 1101, 1110 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.303 (2002).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Service connection is granted for a disability resulting from an injury suffered or disease contracted while in active duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. See 38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 2002); 38 C.F.R. § 3.303

(2002). In general, establishing service connection for a disability requires the existence of a current disability and a relationship or connection between that disability and a disease or injury incurred in service. See 38 U.S.C.A. § 1110 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.303, 3.304

(2002); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992).

I. Entitlement to Service Connection for Anxiety Disorder

The veteran contends that he currently suffers from an anxiety disorder as a result of his active service, and that service connection for his psychiatric disability is appropriate. After a review of the evidence, the Board finds that the record supports his contention, and that service connection for an anxiety disorder is warranted.

Most of the veteran's service medical records are unavailable. The National Personnel Records Center reported that they did not have such records for the veteran, and that they had probably been accidentally destroyed in a 1973 fire at that facility. However, a January 1959 treatment record

states that the veteran complained of chronic anxiety reaction. Another report from January 1959 noted that the veteran was admitted to the hospital in a lethargic state after ingesting an overdose of pills. The February 1959 Medical Evaluation Board report lists a diagnosis of emotional instability reaction including symptoms of lability of emotions, suicidal gesture, lowered tolerance to frustration, difficulty in accepting authority, and somatizations when under stress.

The veteran has also submitted VA outpatient treatment records, statements from his wife, and his own statements to support his claim. VA outpatient records from 1997 to 1999 show treatment for a major depressive order, insomnia, and a history of substance abuse. In the May 2001 hearing

transcript, the veteran as well as his spouse described his symptoms during and after separation from service.

A December 2002 VA examination report lists a diagnosis of anxiety disorder. The examiner noted in his report that the veteran complained of chronic sleep impairment and anxiety during the examination. The examiner also stated that the veteran was casually groomed and cooperative with an anxious mood as well as exhibited limited insight and adequate judgment. No gross memory impairment, hallucinations or delusions were noted in the December 2002 examination report.

The examiner stated that the veteran had received a diagnosis of emotional instability reaction during service, a term that was no longer part of the diagnostic nomenclature. It was noted that the symptoms reported in service appeared to be the same as symptoms described by the veteran in the

examination report. The examiner opined that there appeared to be a nexus between the emotional instability diagnosed in service and the veteran's present symptomatology.

In brief, the record shows that the veteran's current anxiety disorder is related to his period of active service. The opinion contained in the December 2002 VA examination report establishes a link between the veteran's current anxiety disorder and the symptoms diagnosed as an emotional

instability reaction during his active military service. Service medical records reflect that the veteran suffered from an emotional instability reaction while in service. In the December 2002 VA examination report, the examiner specifically stated that the veteran's current disability is

attributable to his period of active military service. The Board finds that the veteran's claim for service connection of an anxiety order must be granted.

II. VCAA

A change in the law, on November 9, 2000, redefined the obligations of VA with respect to the duty to assist and included an enhanced duty to notify the claimant of the information and evidence necessary to substantiate a claim for VA benefits. See Veterans Claims Assistance Act of 2000

(VCAA), 38 U.S.C.A. §§ 5100 et. seq. (West Supp. 2002). Implementing regulations for VCAA have been published. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2002).

Except for amendments not applicable, the provisions of the regulations merely implement the VCAA and do not provide any rights other than those provided by the VCAA.

As noted above, the Board remanded this appeal to the RO in July 2001 for action consistent with the VCAA. As this decision of the Board is a complete grant of the benefit sought on appeal - i.e., service connection for an anxiety disorder - the Board concludes that sufficient evidence to

decide the claim has been obtained and that any defect in the notice and development requirements of the VCAA that may exist in this instance would not be prejudicial to the

veteran.

ORDER

Service connection for an anxiety disorder is granted.

MARY GALLAGHER

Member, Board of Veterans' Appeals

IMPORTANT NOTICE: We have attached a VA Form 4597 that tells

you what steps you can take if you disagree with our

decision. We are in the process of updating the form to

reflect changes in the law effective on December 27, 2001.

See the Veterans Education and Benefits Expansion Act of

2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the

meanwhile, please note these important

Josephine

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Pete,

Free has spend so much time helping me with this claim. She has spent months of her time putting the pieces of the puzzle together for me.

I have had the help of others too and I thank them also. You are one of them yourself.

I have continued to post my story, as I do not ever want anyone to walk in my footsteps.

Free is absolutely correct. That personality is the last thing that I would be.

She has taught me to " Think outside of the Box".

Always,

Josephine

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So it looks like you already appealed in 2004. If your case is set to be reviewed at the Appeals Managment Center very soon - I am not sure what else you can do at this point except wait.

Unless you get confirmation from them of when your case is set for review - and submit a well structured argument before then - and ask that they waive the time-frame for filing evidence and accept it.

They don't like you submitting the same stuff over and over - because that means they have to skim over it and ignore it several times.

But this statement of case seems very incomplete. Not just not detailed enough - but like something that was started but never finished.

I don't see anything on it that gives a bases for denial. It looks like they just listed some of the evidence considered.

I am not sure what the procedure is with the AMC - Are they used INSTEAD of the BVA - or as a step in between?

If they are a step in between - then if they deny the claim - Do they give you a statement of Case? And then you go on to the BVA? I am not sure. I haven;t looked anything up about that.

If they DO deny - and you can appeal to the BVA - I would certainly think that the statement of case you have so far would be deemed inadequate - as it doesn't really give you any valid information on why the case was denied that you could use to perfect your appeal.

However, I am not sure whether you would want to pursue that or not. If you made a case that the Statement of Case was not a valid one - that would give the BVA the opportunity to REMAND the case BACK to the RO - for no other purpose than to issue you a NEW statement of case telling you WHY they denied the claim - so you could RE-APPEAL -- in other words - just give them a tangent to go off on to drag the whole sordid process out for a few more years while pretending they were protecting your rights.

That is just my first thought. Others might have other ideas on the issue.

You might have to bring it up at the BVA level to protect the issue at the court of appeals level - I am not sure.

I was just thinking - Wow! What a crappy SOC they gave you. But when I thought of addressing it - I thought - Wow! They could sure seize that chance to drag the claim out longer.

So I am totally unsure of how to proceed on that one. Just some random thoughts on the issue.

Free

I have my Statement of the Case here at the computer with me and this is what it says.

October 7, 2004

STATEMENT OF THE CASE

WE have enclosed a Statement of the Case, a summary of the law and evidence concerning your claim. This summary will help you to make the best argument to the BVA on why you think that our decision should be changed.

WHAT YOU NEED TO DO:

To complete your appeal, you must file a formal appeal. We have enclosed a VA From 9, Appeal to the Board of Veterans Appeals, which you may use to complete your appeal. We will gladly explain the form if you have questions.

The benefit you want

The facts in the statement of the Case with which you disagree, and

The errors that you believe we made in applying the law

The Division Review Officer ) DRO) has completed a preliminary review of your file and has determined that, based on the evidence currently of record your claim cannot be granted. THIS IS NOT THE DRO'S FINAL DECISION.

We are sending you this Statement of the Case so that you can better understand your appeal. An examination is being scheduled at the VA Medical Center. The Va Medical Center will notify you about the date and time to report for the examination.

DECISION:

Service connection for chronic anxiety with depression is denied

REASONS AND BASES

The additional service medical records submitted from The National Personnel Records Center and the report form Dr. P dated april 2004, are considered to be both new and material and your claim for service connection for an acquired psychiatric disorder is reopened.

You were seen for a psychiatric consultation in March 1964. You complained about being unhappy with the Navy since boot camp. Assessment was emotional immaturity, dependency, and instability which precluded futher military service. Your post treatment records show that you were diagnosed with anxiety in 1979 ( WHAT A JOKE, THEY WERE SITTING THERE WITH MY MEDICAL RECORDS FROM 1965 TO DATE) Dr. P reported that he reviewed your March 1964 psychiatric consulatations and expressed an opinion that your current anxiety and depresssion began in service.

How do you fill out a Form - 9 on this Statement of the Case?

1. I turned in the " Psychiatric Records from the Archives in March 2004. This was 7 months before this decision was made. You would think that by reading this, that I turned them after this Statement of the Case.

I called the counslors about the Statment of the Case. They said get that form - 9 filled out and back in within 60 days.

I did.

Josephine

Think Outside the Box!
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Josephine,

I am not real clear here - this says it is a prelimanary review - and NOT a final decision of the DRO MAKE a final decision?

It seems like they would have made a final decision after that and then sent you an actual statement of Case BEFORE you filed the appeal.

I am concerned on this one. Because if the AMC denies it - and then you have to appeal THAT to the BVA - then can the BVA let it sit THERE a couple years and then REMAND it saying the DRO had NOT made a final decision and thus, they have no jurisdiction to hear the case?

I don;t know. Maybe I am missing something.

I know that my husband appealed his original claim - and it sat at the BVA for a LONG time -- and when they finally set it for review - they sent it BACK to the RO - because the RO had not sent a copy of his DD-214 along with the file.

So it took THEM 6 months to send it BACK to the BVA before they looked at it.

And I have read a lot of cases where the BVA will decide they can't hear the case because the person wasn't given a Statement of Case, or something or the other. So they remand it BACK to the RO before they can hear it.

So does anyone know?

Does this Statement of Case even COUNT as a Statement of Case? Did the DRO ever make a decision?

Free

So it looks like you already appealed in 2004. If your case is set to be reviewed at the Appeals Managment Center very soon - I am not sure what else you can do at this point except wait.

Unless you get confirmation from them of when your case is set for review - and submit a well structured argument before then - and ask that they waive the time-frame for filing evidence and accept it.

They don't like you submitting the same stuff over and over - because that means they have to skim over it and ignore it several times.

But this statement of case seems very incomplete. Not just not detailed enough - but like something that was started but never finished.

I don't see anything on it that gives a bases for denial. It looks like they just listed some of the evidence considered.

I am not sure what the procedure is with the AMC - Are they used INSTEAD of the BVA - or as a step in between?

If they are a step in between - then if they deny the claim - Do they give you a statement of Case? And then you go on to the BVA? I am not sure. I haven;t looked anything up about that.

If they DO deny - and you can appeal to the BVA - I would certainly think that the statement of case you have so far would be deemed inadequate - as it doesn't really give you any valid information on why the case was denied that you could use to perfect your appeal.

However, I am not sure whether you would want to pursue that or not. If you made a case that the Statement of Case was not a valid one - that would give the BVA the opportunity to REMAND the case BACK to the RO - for no other purpose than to issue you a NEW statement of case telling you WHY they denied the claim - so you could RE-APPEAL -- in other words - just give them a tangent to go off on to drag the whole sordid process out for a few more years while pretending they were protecting your rights.

That is just my first thought. Others might have other ideas on the issue.

You might have to bring it up at the BVA level to protect the issue at the court of appeals level - I am not sure.

I was just thinking - Wow! What a crappy SOC they gave you. But when I thought of addressing it - I thought - Wow! They could sure seize that chance to drag the claim out longer.

So I am totally unsure of how to proceed on that one. Just some random thoughts on the issue.

Free

Think Outside the Box!
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Thanks Pete and Josephine! I am flattered. Especially since I still don't know all that much about the BVA - but I do know how to take arguments apart and how to put arguments together.

By the way Josephine - did you see the picture of my husband and I that I put on with my name. That is our wedding picture!

Free

Pete,

Free has spend so much time helping me with this claim. She has spent months of her time putting the pieces of the puzzle together for me.

I have had the help of others too and I thank them also. You are one of them yourself.

I have continued to post my story, as I do not ever want anyone to walk in my footsteps.

Free is absolutely correct. That personality is the last thing that I would be.

She has taught me to " Think outside of the Box".

Always,

Josephine

Think Outside the Box!
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http://www.hadit.com/forums/index.php?showtopic=2639

http://www.hadit.com/forums/index.php?showtopic=2639

These links might also be useful. They go into what Berta has discussed how the court has ruled the VA is not allowed to go on a "fishing expedition" to gt evidence AGAINST your case.

If you already had evidence - and your own doctors report and a C&P exam IN YOUR FAVOR - they don't really have the right to seek ANOTHER opinion without having good reasons and bases for why such an opinion is neccesary.

By the way - was the second C&P AFTER the partial statement of case they gave you in 2004?

I am not sure - but it would seem like if they had already sent you for ONE C&P - they would have to notify you that they were sending you on a SECOND one - and WHY they felt it necessary to do that.

Does anyone know --

Do the reasons and bases for the additonal evidence have to be given to the vet BEFORE they send them for an extra C&P or seek another medical opinion?

I think the strength of your argument here will lie in the fact that they were not presented with a couple half-hearted medical opinions.

They HAD a C&P that was done by the doctor THEY CHOSE!

It would seem like they would have to have a DANG good reason to send you to a DIFFERENT doctor of their choosing, rather than merely contacting the FIRST doctor THEY sent you to, if they had any questions.

Free

Think Outside the Box!
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  • HadIt.com Elder

Thanks Pete and Josephine! I am flattered. Especially since I still don't know all that much about the BVA - but I do know how to take arguments apart and how to put arguments together.


By the way Josephine - did you see the picture of my husband and I that I put on with my name. That is our wedding picture!


Free

Free,

I have wanted to ask you countless times about the beautiful picture, but I didn't know how to ask you.

I think that you read my thoughts. I wanted to ask you if that was your husband.

The picture is simply lovely and I appreciate your placing it on the post for all of us to see.

As I have said so many times , you are a very gracious lady.

Always,

Josephine

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